October 30 through November 20, 2019 at noon EST Look Again Find - PowerPoint PPT Presentation

SPD Benefits October 30 through November 20, 2019 at noon EST Look Again – Find the Right Fit

Wellne ness ss • Wellness CDHP will no longer be offered • Employees who qualified for the Wellness Premium Discount can use this discount on any medical plan selected • Premium reduction will be automatically reflected • If enrolled in Wellness CDHP for 2019, plan will default to CDHP 1 for 2020, unless another plan is selected. Welln ellnes ess P Prem emiu ium Discount: • Single = $374.44 • Family = $1,123.20

CDHP HP 1 1 • No premium increase! • Premiums for the CDHP 1 with the wellness incentive rate are lower than the current Wellness CDHP rates 2020 2019 2019 CDHP 1 Wellness CDHP Bi-Weekly Plan Coverage Bi-Weekly Bi-Weekly Employee Rate Employee Rate Employee Rate Single $68.84 $68.84 CDHP 1 Family $138.80 $138.80 CDHP 1 Single $33.84 $33.84 W/ Non-Tobacco Use Incentive Family $103.80 $103.80 Wellness Incentive Rates Single $54.44 $54.98 CDHP 1 Family $95.60 $98.48 CDHP 1 Single $19.44 $19.98 W/ Non-Tobacco Use Incentive Family $60.60 $63.48

CDHP HP 1 1 (co continued ed) • Deductible is the same • Single: $2,500 • Family: $5,000 • Out-of-Pocket is the same • Single: $4,000 • Family: $8,000 • Family Individual Embedded Out-of-Pocket no longer applies • Coinsurance amounts are the same • 80% / 20% for in-network services after the deductible • Prescription Copays and Coinsurance are the same

CDHP HP 2 2 • Premiums are decreasing! 2020 2019 Bi-Weekly Bi-Weekly Plan Coverage Employee Employee Rate Rate Single $81.90 $159.20 CDHP 2 Family $186.54 $391.82 CDHP 2 Single $46.90 $124.20 W/ Non-Tobacco Use Incentive Family $151.54 $356.82 Wellness Incentive Rates Single $67.50 CDHP 2 Family $143.34 CDHP 2 Single $32.50 W/ Non-Tobacco Use Incentive Family $108.34

CDHP HP 2 2 (co continued ed) • Deductible is increasing • Single: $1,500 to $1,750 • Family: $3,000 to $3,500 • Out-of-Pocket is the same • Single: $3,000 • Family: $6,000 • Coinsurance amounts are the same • 80% / 20% for in-network services after the deductible • Prescription Copays and Coinsurance are the same

Tradi aditi tional al P Plan • Premiums are decreasing! 2020 2019 Bi-Weekly Bi-Weekly Plan Coverage Employee Employee Rate Rate Single $134.40 $397.40 Traditional Family $374.64 $1,062.26 Traditional Single $99.40 $362.40 W/ Non-Tobacco Use Family $339.64 $1,027.26 Wellness Incentive Rates Single $120.00 Traditional Family $331.44 Traditional Single $85.00 W/ Non-Tobacco Use Family $296.44

Tradi aditi tional al P Plan ( (co continued ed) • Deductible is increasing • Single: $750 to $1,000 • Family: $1,500 to $2,000 • Out-of-Pocket is decreasing • Single: $3,000 to $2,500 • Family: $6,000 to $5,000 • Coinsurance amounts are decreasing • 2019: 30% / 70%* • 2020: 20% / 80%* • Prescription copays and coinsurance are decreasing • Generic: $20 to $10* • Preferred Brand Name: 30% to 20%* • Non-Preferred Brand Name: 50% to 40%* • Specialty: 50% to 40%* *in-network services after deductible

Plan S Speci cifics - Medical CDHP 1 CDHP 2 Traditional Plan In Out of In Out of In Out of Network Network Network Network Network Network Deductible Single $2,500 $1,750 $1,000 Family $5,000 $3,500 $2,000 Out-of-Pocket Maximum Single $4,000 $3,000 $2,500 Family $8,000 $6,000 $5,000 Office Visit 20% 40% 20% 40% 20% 40% Inpatient 20% 40% 20% 40% 20% 40% Emergency Room 20% 20% 20% 20% 20% 20% Urgent Care 20% 20% 20% 20% 20% 20% 0% 40% 0% 40% 0% 40% Wellness and Prevention (no deductible) (no deductible) (no deductible) (no deductible) (no deductible) (no deductible)

Bi-Weekly Medi dical P Plan R Rates Plan Single Family $68.84 $138.80 CDHP1 $33.84 $103.80 CDHP1 (w/ non-tobacco use incentive) $81.90 $186.54 CDHP2 $46.90 $151.54 CDHP2 (w/ non-tobacco use incentive) $134.40 $374.64 Traditional $99.40 $339.64 Traditional (w/ non-tobacco use incentive) Wellness Incentive Rate $54.44 $95.60 CDHP1 $19.44 $60.60 CDHP1 (w/ non-tobacco use incentive) $67.50 $143.34 CDHP2 $32.50 $108.34 CDHP2 (w/ non-tobacco use incentive) $120.00 $331.44 Traditional $85.00 $296.44 Traditional (w/ non-tobacco use incentive)

Presc scription C Coverage CVS C Caremark • Prescription benefit copay and coinsurance tier design will change for the Traditional plan • Large network of participating pharmacies • There is no requirement to switch to a CVS pharmacy • For a full list of in-network pharmacies near you, please visit www.caremark.com • 90-Day refills can be filled through CVS Caremark Mail Service Pharmacy or CVS Pharmacy Locations • Point-of-Sale Rebates • Reduces employee cost of prescription prior to deductible being met • Example: List price $250, Rebate $100 – your cost will be $150 • User friendly CVS Caremark website and mobile app • Review your mail order prescriptions • Check drug costs and coverage • Find network pharmacies • Keep track of prescription spending • Transfer or submit a prescription by submitting picture of prescription or prescription label

Plan S Speci cifics - Presc scription CDHP 1 CDHP 2 Traditional Plan Mail or CVS Mail or CVS Mail or CVS Retail Retail Retail Prescription Drug Pharmacy Pharmacy Pharmacy (up to 30 days) (up to 30 days) (up to 30 days) (up to 90 days) (up to 90 days) (up to 90 days) Preventive (ACA $0 $0 $0 $0 $0 $0 mandated) no deductible no deductible no deductible no deductible no deductible no deductible Generic Medicines $10 co-pay $20 co-pay $10 co-pay $20 co-pay $10 co-pay $20 co-pay Formulary: 20% 20% 20% 20% 20% 20% Preferred Min $30 Min $60 Min $30 Min $60 Min $30 Min $60 Brand-Name Max $50 Max $100 Max $50 Max $100 Max $50 Max $100 Medicines Non-Preferred 40% 40% 40% 40% 40% 40% Brand-Name Min $50 Min $100 Min $50 Min $100 Min $50 Min $100 Medicines Max $70 Max $140 Max $70 Max $140 Max $70 Max $140 40% 40% 40% Specialty Medicines Min $75, Max $150 Min $75, Max $150 Min $75, Max $150 (30 day supply) (30 day supply) (30 day supply)

No Non-Toba bacco Us Use e Agreem eemen ent P Polic licy C Cha hang nge • Only proof of use of an FDA approved Nicotine Replacement Therapy product will be accepted as evidence to rebut the presumption of tobacco use that constitutes a breach of the Non-Tobacco Use Agreement. • FDA approved medications for smoking cessation can be found at https://www.fda.gov/consumers/consumer-updates/want- quit-smoking-fda-approved-products-can-help. • Vaping and E-cigarettes products are not legitimate, FDA approved nicotine replacement therapy products

No Non-Tob obacco U Use I Incentive Incentive for 2020 is a $35 reduction in your bi-weekly health plan premium. 1. I agree to abstain from using any tobacco products during 2020. 2. I understand that to receive the reduction in premium, I may be subject to cheek swab tests for cotinine (an alkaloid in tobacco and metabolite of nicotine), and I agree to submit to such testing. A positive test result creates a rebuttable presumption of tobacco use and breach of this agreement. Refusal to submit to testing constitutes a breach of this agreement. 3. I understand and agree if I accept this agreement and later use tobacco or otherwise breach this agreement, my employment will be terminated, for breach of this agreement and inappropriately taking the $35.00 bi-weekly premium reduction. 4. The only exception to the job loss penalty is if I revoke this agreement by logging into PeopleSoft and completing the self-service process to revoke my agreement prior to using any tobacco product. 5. Only proof of use of an FDA approved Nicotine Replacement Therapy product will be accepted as evidence to rebut the presumption of tobacco use that constitutes breach of this agreement. FDA approved medications for smoking cessation can be found at https://www.fda.gov/consumers/consumer-updates/want-quit-smoking-fda-approved-products-can-help. Vaping and e- cigarette products are not legitimate, FDA approved nicotine replacement therapy products. 6. If I breach or revoke this agreement, I agree to repay the State of Indiana for each $35.00 bi-weekly premium reduction I received for 2020. This repayment may be made via payroll deduction if I remain employed with the State of Indiana after the revocation requiring repayment. 7. For enforcement of this agreement, I consent to the release of cotinine test results to management representatives of my employer. Otherwise, disclosure of the cotinine test results are restricted consistent with the Notice of Indiana State Employee Group Insurance Plan - Privacy Practices, http://www.in.gov/spd/files/HIPAA-Privacy-Notice.pdf. Notice: If your physician determines abstaining from the use of tobacco is not medically appropriate, a reasonable alternative standard will be made available for the incentive.